Oh,
what about us?
What about all the plans that ended in disaster?
What about love? What about trust?
What about us?
P!nk:
What About Us
Over six years ago, I actually wrote a blog post of a similar theme and inspired by the exact same song (P!nk: What About Us – which you can listen to here) that led to this post too (you can read that post here), so I was in two minds as to publishing this. Eventually, however, I recognised that there has been a huge increase in the blog’s readership since then, and so it’s incredibly likely that there’ll be a lot of people out there who actually haven’t seen, heard of, or read that piece. I also realised that I have a lot of new ideas and experience on this topic, so it’s likely not going to be much of a repeat at all...
I wanted to start this post with some statistics and information I’ve found through research because they will illustrate why this topic is so important through supporting the fact that services are failing by showing that neither contacting a mental health service nor even being an inpatient, are protective factors – particularly when it comes to suicide…
·
27%
of all those who have committed suicide in the UK have had contact with mental
health services within the 12 months prior to their death: NCISH | Mental health patient
suicide
·
4%
of all patient suicides occur within psychiatric hospitals; with 40% occurring
on a ward, 50% occurring whilst the patient is on leave from hospital, and 10% by
patients who are AWOL: NCISH | Key findings
·
13%
of mental health service users have committed suicide within three months of
discharge from a psychiatric hospital: NCISH | Key findings
·
Globally,
25 – 40% of those who commit suicide have had recent contact with a mental
health service: Suicide prevention - Wikipedia
·
Those
who are starting treatment with a mental health service, have been admitted to
hospital, or are within three months post-discharge from a psychiatric
hospital, are 191 times more likely to commit suicide: Diagnosed Mental Health
Conditions and Risk of Suicide Mortality - PMC
·
41%
of people who reported unfair treatment by mental health services, went without
needed care: Racial and Ethnic Disparities in
Mental Health Care: Findings from the KFF Survey of Racism, Discrimination and
Health | KFF
1. Long Waiting Times: Many people face months-long
waits for initial assessments or treatment, which worsens symptoms and reduces
the chances of early intervention success.
ü Increase Funding and Workforce
Capacity
Expand
budgets specifically earmarked for mental health to hire more therapists,
psychologists, psychiatrists, and support staff.
Provide
incentives for mental health professionals to work in public health systems or
underserved areas.
ü Implement Early Intervention and
Prevention Programs (more on these later)
Invest
in school-based, workplace, and community mental health initiatives that reduce
the need for acute services by catching problems early.
Provide
self-help resources and resilience training to reduce the severity of cases
reaching clinical thresholds.
ü Expand Use of Digital Mental
Health Tools
Provide
access to evidence-based digital therapies (e.g., CBT apps, online counselling)
to help manage mild to moderate symptoms, freeing up clinicians for more
complex cases.
Use
AI-driven triage systems to better prioritize who needs urgent human
intervention.
ü Improve Referral Pathways and
Triage Systems
Streamline
referrals so patients are sent to the right service the first time, avoiding
unnecessary delays or assessments.
Establish
clear criteria and fast-track processes for urgent cases.
ü Leverage Community and Peer
Support
Utilize
trained peer support workers and community organizations to provide support for
people on waiting lists, reducing deterioration while they wait.
ü Address Workforce Retention and
Training
Reduce
burnout through better working conditions, supervision, and career development
opportunities to retain existing staff.
Increase
training placements for future mental health professionals.
ü Flexible Service Delivery Models
Extend
service hours into evenings and weekends to maximize appointment availability.
Offer
hybrid (in-person and virtual) appointments to reduce geographic and scheduling
barriers.
2. Underfunding and Lack of Resources: Mental health services often
receive significantly less funding than physical health services, leading to
understaffing, outdated facilities, and limited treatment options.
ü Integrate Mental Health into
Broader Health Budgets
Push
for mental health to be treated equally within healthcare budgets ("parity
of esteem") alongside physical health, ensuring a mandated percentage of
health spending is dedicated to it.
ü Reallocate Existing Resources
Strategically
Advocate
for health systems to review inefficiencies or overspending in other areas
(such as excessive inpatient costs) and redirect funds toward preventative and
community-based mental health services.
ü
Secure
Dedicated Government Commitments
Lobby
for legally binding commitments to increase mental health budgets year-on-year,
similar to targets set for other health priorities like cancer care.
ü Innovative Funding Models
Explore
social impact bonds or partnerships with private and philanthropic sectors to
co-fund mental health initiatives with measurable outcomes.
ü Empower Local Authorities
Provide
local governments with the autonomy and budgetary flexibility to invest in
tailored mental health solutions that address community-specific needs.
ü Workforce Development Funding
Make
the case for funding dedicated to training and expanding the mental health
workforce as part of broader employment and skills development policies.
ü Embed Mental Health in All
Policies
Advocate
for a "mental health in all policies" approach, ensuring that
infrastructure projects, urban planning, social policies, and educational
reforms include mental well-being outcomes in their funding criteria.
3. Over-Reliance on Medication: There’s often an overemphasis on
prescribing medication as a quick fix, while access to therapies like CBT,
trauma counselling, or holistic approaches is limited.
ü Expand Access to Psychological
Therapies
Increase
availability of evidence-based therapies (CBT, DBT, EMDR, ACT, etc.) through
public services, insurance coverage, or community-based programs.
Reduce
waiting lists so therapy is a realistic option, not an alternative people give
up on.
ü Adopt a Holistic, Person-Centred
Care Model
Encourage
services to treat people as individuals, considering social, psychological, and
lifestyle factors alongside medical ones.
Use
care plans that include therapy, peer support, lifestyle changes, and social
interventions as standard practice.
ü Reform Clinical Guidelines and
Incentives
Update
clinical guidelines to prioritize psychological and social interventions as
first-line treatments where appropriate.
Ensure
funding models don't financially incentivize prescribing over therapy (e.g.,
time-pressured primary care models).
ü Train Clinicians in Alternatives
to Medication
Provide
more training for GPs, psychiatrists, and nurses in non-medical approaches to
mental health.
Promote
understanding of trauma-informed care, psychosocial models, and recovery
approaches among all healthcare staff.
ü Improve Informed Consent and
Patient Education
Ensure
patients understand the risks, benefits, and limitations of medication, as well
as the availability of alternative treatments.
Normalize
conversations about coming off medication safely when appropriate.
ü Promote Social Prescribing
Integrate
social prescribing (e.g., exercise, volunteering, community groups) into mental
health care to address loneliness, inactivity, and life stressors.
ü Address Systemic Pressures on
Clinicians
Tackle
workload pressures that lead clinicians to default to medication because it’s
quicker than arranging therapy or support.
Reform
appointment structures to allow time for meaningful therapeutic conversations,
not just prescriptions.
ü Challenge Cultural Assumptions
About Medication
Public
campaigns and educational efforts can shift perceptions away from viewing
medication as the only legitimate or scientific treatment for mental distress.
Promote
narratives of recovery that involve holistic approaches, not just medication.
4. Inadequate Crisis Services: Emergency mental health care is
often lacking, with too few crisis teams or inpatient beds. People in crisis
are sometimes turned away or left to deteriorate until hospitalization is the
only option.
ü Establish 24/7 Crisis Response
Teams
Create
multidisciplinary teams (psychiatrists, psychologists, nurses, peer workers)
available around the clock to provide rapid, community-based crisis
interventions.
Reduce
the reliance on police or emergency departments for mental health crises.
ü Develop Crisis Stabilization
Units (CSUs)
Provide
short-term, safe, therapeutic environments specifically designed to de-escalate
crises without resorting to hospitalization.
These
units should offer immediate assessment, short stays, and links to follow-up
care.
ü Expand Crisis Phone Lines and
Digital Support
Ensure
24/7 helplines staffed by trained professionals who can provide immediate
de-escalation, support, and referral options.
Integrate
text, chat, and video services for those who may not want to speak by phone.
ü Enhance Crisis Prevention
Planning
Co-produce
detailed crisis plans with patients during stable periods, outlining triggers,
preferred interventions, and emergency contacts.
Ensure
these plans are accessible to all relevant services.
ü Improve Access to Non-Medical
Crisis Alternatives
Develop
alternatives like crisis cafés, safe spaces, and community havens where people
can go voluntarily to receive support and avoid hospitalisation.
ü Provide Rapid Access to
Follow-Up Care
Ensure
people discharged from crisis services receive timely follow-up within 24-72
hours to prevent relapse and reinforce stability.
ü Coordinate Across All Services
(Particularly Emergency Services)
Integrate
crisis teams with police, ambulance, A&E, housing, and social services to
ensure people receive appropriate, joined-up responses.
Develop
shared protocols to avoid people being bounced between services.
ü Embed Rights-Based and
Trauma-Informed Approaches
Ensure
crisis services uphold dignity, choice, and autonomy wherever possible.
Minimize
coercive interventions (e.g., forced treatment, restraint) and prioritize
de-escalation and consent-based care.
5. Stigma Within the System: Despite being healthcare
providers, some mental health services still harbour stigmatizing attitudes
towards patients, particularly those with complex or long-term conditions.
ü Embed Lived Experience
Leadership
Involve
people with lived experience of mental health issues at all levels: in service
design, governance, staff recruitment, training, and quality improvement.
Appoint
lived experience advisors or peer support workers to challenge stigma from
within.
ü Mandatory Anti-Stigma and Bias
Training
Deliver
ongoing, evidence-based training on stigma, unconscious bias, trauma-informed
care, and recovery-oriented practice to all staff (clinical and non-clinical).
Move
beyond awareness to focus on behaviour change, attitudes, and practical
strategies.
ü Promote a Recovery-Oriented
Culture
Shift
organizational values to prioritize hope, agency, strengths, and the belief in
recovery, rather than a purely medical or risk-based model.
Incorporate
recovery principles into policies, supervision, and performance metrics.
ü Improve Reflective Practice and
Supervision
Foster
reflective spaces where staff can explore their attitudes, biases, and fears
about mental health openly and safely.
Incorporate
stigma awareness into clinical supervision processes.
ü Encourage Open Dialogue and
Feedback from Service Users
Create
mechanisms for regular, honest feedback from patients about how they experience
stigma within services.
Respond
transparently and proactively to any reported incidents of dismissiveness or
discrimination.
ü Model Respectful, Compassionate
Leadership
Leaders
should actively model non-stigmatizing language, attitudes, and behaviours in
all interactions.
Leaders
should speak publicly and internally about the importance of dignity and
respect in care.
ü Promote Co-Production of
Services
Ensure
that services are designed with, not just for, people who use them.
Co-production embeds respect, equality, and shared responsibility.
ü Highlight Positive Stories and
Role Models
Share
recovery stories and examples of positive outcomes throughout the organization
to counter internalized stigma and defeatism.
Celebrate
service users’ achievements publicly within the service.
ü Review Policies for Stigmatizing
Practices
Audit
policies, procedures, and materials for language and processes that perpetuate
stigma (e.g., labelling, excessive risk focus, inflexible pathways).
Update
documentation to reflect dignity, choice, and recovery-oriented values.
6. Fragmented and Disjointed Care: Poor communication and
coordination between services (primary care, specialists, social services)
often result in patients falling through the cracks.
ü Develop Integrated Care
Pathways
Create clear, standardized care pathways that
connect primary care, mental health services, social services, and crisis care.
Ensure these pathways are easy for both
professionals and service users to navigate.
ü Implement
Shared Digital Health Records
Use shared electronic health records
accessible across services (GPs, psychiatrists, psychologists, social workers)
to prevent information gaps and duplication.
Ensure consent is clearly explained and
obtained from patients.
ü Establish
Multidisciplinary Teams (MDTs)
Form integrated teams comprising mental health
professionals, GPs, social workers, peer support, housing officers, and
substance use specialists.
Regular MDT meetings ensure coordination and
holistic planning for complex cases.
ü Designate
Care Coordinators or Key Workers
Assign a single point of contact (care
coordinator) to oversee the individual’s care journey, ensuring smooth
transitions between services.
Particularly effective for people with severe,
complex, or long-term mental health needs.
ü Improve
Communication Protocols Between Services
Develop clear guidelines for timely
information sharing, referrals, and handovers between organizations.
Use standardized referral forms, joint
meetings, and shared care agreements.
ü Enhance
Crisis and Out-of-Hours Integration
Ensure crisis services are fully linked with
ongoing care teams to avoid fragmented responses during emergencies.
Shared protocols for risk, medication, and
aftercare between crisis and routine services.
ü Foster
Partnership with Third Sector and Community Services
Build structured partnerships with charities,
peer-led groups, housing services, and employment support to provide truly
holistic care.
Formalize these links through contracts,
protocols, and joint care plans.
ü Include
Service Users in Coordinating Their Care
Co-produce care plans with individuals,
empowering them to understand and shape how their care is coordinated across
services.
Use tools like Wellness Recovery Action Plans
(WRAP) to give people ownership over their recovery.
7. Lack of Culturally Competent Care: Services often fail to
understand or accommodate the cultural, linguistic, and religious needs of
diverse populations, leading to mistrust and disengagement.
ü Mandatory
Training in Cultural Competence and Anti-Racism
Provide staff with ongoing, evidence-based
training on cultural competence, unconscious bias, anti-racism, and the impacts
of structural inequalities on mental health.
Move beyond awareness to practical strategies
for adapting care to different cultural contexts.
ü Diversify
the Workforce
Actively recruit and retain staff from a range
of ethnic, cultural, and linguistic backgrounds.
Ensure leadership teams reflect the diversity
of the communities served to influence policy and culture at the highest
levels.
ü Co-Produce
Services with Marginalized Communities
Involve people from diverse backgrounds in the
design, delivery, and evaluation of services to ensure they reflect cultural
needs and realities.
Establish advisory panels or working groups
specifically focused on race, culture, and inclusion.
ü Provide
Language and Interpretation Services
Ensure high-quality interpreters are available
for all services, including therapy.
Offer information, resources, and care
pathways in multiple languages.
ü Adapt
Therapies to Cultural Contexts
Train therapists to adapt evidence-based
interventions (CBT, family therapy, etc.) to align with cultural values,
beliefs, and explanatory models of mental distress.
Use culturally specific therapeutic models
where appropriate.
ü Build
Partnerships with Community and Faith Organizations
Collaborate with trusted community leaders,
faith groups, and grassroots organizations to improve outreach, referrals, and
culturally safe spaces for care.
Leverage these partnerships to reduce stigma
and build trust.
ü Personalize
Care Through Culturally Informed Assessments
Incorporate cultural formulation tools (e.g.,
DSM-5 Cultural Formulation Interview) into assessments to understand how
culture affects symptom expression and help-seeking.
ü Address
Systemic Racism in Policy and Practice
Audit organizational policies and practices
for structural biases that disproportionately harm racialized or marginalized
groups (e.g., overuse of detention powers, misdiagnosis).
Commit to action plans that dismantle these
barriers at every level of care.
8. Insufficient Support for Severe or
Complex Cases: Those
with severe mental illnesses, dual diagnoses (e.g., mental health + substance
use), or personality disorders are often denied adequate, tailored support.
ü Develop
Integrated, Multi-Disciplinary Teams (MDTs)
Build specialist teams that bring together
psychiatry, psychology, social work, occupational therapy, substance misuse
specialists, physical health clinicians, and peer support workers.
Enable holistic care planning through regular
MDT meetings.
ü Create
Dedicated Pathways for Complex Needs
Establish clear pathways for people with dual
diagnoses (e.g., mental illness and addiction), personality disorders, or
neurodiverse conditions, ensuring they aren’t excluded or bounced between
services.
Provide continuity across crisis care,
inpatient, outpatient, and community settings.
ü Invest in
Specialist Services
Expand services specifically designed for
complex presentations, such as: Trauma-informed care services, Forensic mental
health services, Neurodiversity-informed mental health care, Complex PTSD and
dissociation services.
ü Improve
Collaboration Between Mental and Physical Health Services
Integrate mental health with general
healthcare services to better manage co-occurring physical health issues (e.g.,
through liaison psychiatry or health and wellbeing hubs).
ü Implement
Trauma-Informed and Person-Centred Approaches
Ensure all services are equipped to work
compassionately with trauma, complex attachment issues, and histories of abuse.
Focus on individualized care plans and
flexible treatment options rather than rigid protocols.
ü Strengthen
Workforce Skills and Supervision
Train clinicians to work effectively with
complexity, including in areas like trauma, neurodiversity, dual diagnosis, and
risk management.
Provide reflective practice and specialist
supervision to support staff dealing with challenging cases.
ü Ensure
Robust Transition Support Between Services
Improve handovers between child and adult
services, inpatient and community teams, or between sectors (health, social
care, justice) to ensure no one is lost during transitions.
9. Inaccessible for Marginalized Groups:
Services are
often not designed to meet the needs of LGBTQ+ individuals, neurodivergent
people, the homeless, or those living in poverty, perpetuating exclusion.
ü Co-Design Services with
Marginalized Communities
Involve
people from marginalized groups in the design, delivery, and evaluation of
services through advisory boards, focus groups, and co-production.
Ensure
services reflect the real needs, experiences, and cultural contexts of those
communities.
ü Embed Equity, Diversity, and
Inclusion (EDI) into Policy and Practice
Develop
and enforce organizational strategies that prioritize inclusion,
anti-discrimination, and culturally safe care.
Audit
services regularly for inequities in access, experience, and outcomes, and act
on the findings.
ü Diversify the Workforce
Recruit
and retain staff who reflect the communities served in terms of race,
ethnicity, gender, sexuality, language, disability, and lived experience.
Ensure
diversity is present not just at frontline level but also in leadership and
decision-making roles.
ü Offer Language Support and
Accessible Communication
Provide
high-quality interpretation, translation, and communication aids (sign language
interpreters, Easy Read materials, visual aids).
Ensure
information about services is available in multiple languages and accessible
formats.
ü Reduce Bureaucratic and
Financial Barriers
Simplify
referral processes and allow for self-referral where possible.
Ensure
services are free at the point of access and actively mitigate indirect costs
(transport, childcare, technology).
ü Train Staff in Cultural
Competence and Intersectionality
Equip
staff with skills to understand how intersecting identities (race, disability,
gender, poverty, immigration status) shape mental health and service
experiences.
Deliver
training on anti-racism, LGBTQ+ inclusivity, trauma-informed care, and
neurodiversity.
ü Develop Tailored and Specialized
Services
Establish
dedicated services or pathways for marginalized groups where appropriate (e.g.,
LGBTQ+ affirmative therapy, services for refugees, culturally specific
services).
Adapt
mainstream services to be genuinely inclusive, not simply add-on services.
ü Tackle Stigma and Build Trust
Run
public health campaigns to reduce stigma within marginalized communities around
mental health and help-seeking.
Partner
with trusted community leaders to break down fear and distrust of services,
particularly among groups historically harmed by institutions.
ü Monitor and Act on Disparities
Collect
detailed data on who is using services, who isn’t, and why.
Use
this data to set measurable goals for improving access and equity — and hold
leaders accountable for progress.
10. Lack of Focus on Prevention and
Early Intervention: Systems
are reactive rather than proactive, with minimal investment in preventing
mental health issues or supporting mental well-being before crises develop.
ü Invest in Early Intervention
Services
Expand
specialized services like Early Intervention in Psychosis (EIP) and
first-episode mental health programs for young people.
Provide
early access to psychological therapies, not just medication.
ü Integrate Mental Health into
Primary Care and Schools
Embed
mental health practitioners within GP practices, schools, and colleges to
ensure early detection and easy access to support.
Provide
training for teachers and primary care professionals to spot early warning
signs.
ü Promote Public Mental Health and
Wellbeing Initiatives
Run public
health campaigns to reduce stigma, promote mental wellbeing, and encourage
early help-seeking.
Focus
on communities at higher risk (e.g., young people, marginalized groups,
carers).
ü Make Self-Referral Routes Widely
Available
Simplify
access to mental health support through self-referral systems, helplines, apps,
and drop-in services — avoiding GP or crisis team gatekeeping.
ü Train the Workforce to Identify
Early Signs
Provide
ongoing training for all healthcare workers (including non-specialists) in
recognizing early symptoms of mental health issues and taking appropriate
action.
Encourage
proactive conversations about mental health in routine care.
ü Ensure Funding Prioritizes
Prevention
Advocate
for ring-fenced budgets specifically for prevention and early intervention to
protect these services from cuts when demand for acute care rises.
Shift
financial incentives from crisis management to long-term wellbeing.
ü Collect and Use Data to
Demonstrate Impact
Track
outcomes and cost savings from prevention and early intervention work to build
the case for continued investment.
Share
success stories to influence policy and funding decisions.